Edward Food Research & Analysis Centre Limited, Barasat, W.B.

MSP/SOP/WKI/FRM
TEST REQUEST FORM
Revision Number : 06 QA 15.0.0.1 Page 1 of 2

Requisition No.: *Date: 14/03/2022 Time: 11:16 AM

*Company Name& Address for Report Generation: *Contact person to appear on Test Reports:
NATURAL PRODUCT MANUFACTURERS SUMIT KUMAR GHOSH
315A BADU ROAD MADHYAMGRAM P.O.
ABDALPUR KOLKATA- 700155
PIN CODE- 700155 *Phone: 9830165125
Fax:
*Company Name &Address for Invoice Generation: *e-mail:npm.office1@gmail.com
NATURAL PRODUCT MANUFACTURERS
315A BADU ROAD MADHYAMGRAM P.O.
*GST ID: 19AASFN0083E1Z3
ABDALPUR KOLKATA- 700155
PIN CODE-700155
I here by declare that the sample(s) detailed below / are submitted with the knowledge and authority of my company,
and on behalf of my company for analysis as per the following requisition.
Signature of Client I Representative: Name: Sumit Kumar Ghosh
Date 14/03/2022 Designation: Partners

REQUISITION FORTESTING (Sample Details & Test Required)

*Should the
Sl. *Sample Name / ID *Quantity *Test Parameters Required for *Test Methods Limits be
No. Analysis / Quotation Reference mentioned
or not?
Sample Name: DBS
1. 100 Gm Chloride and Sulphate Test QA16.5.1 YES
Batch No.: DBS-99
Sample Name: Sulphuric
2. Acid 200 Gm Lead, Cadmium, Arsenic, Copper, QA.16.5.2/AOAC YES
Tin, Mercury, Methyl Mercury 20th Edition
Batch No.:

Sample Name: DBS Nutrition Value Test of As per

2. 300 Gm Calorie, Protein, Total Fat, company YES
Batch No.: DBS-99 Cholesterol, Total Carbohydrate norms

Storage Condition: At normal room Temperature

Special Instruction (if any):
Report Required Within:
Reference: Work Order No. (P. O. for each Sample)
Verify Physical Condition of Sample: OK Not OK
If Not Ok, Please describe about the discrepancy ………………………………………………………………………………
………………………………………………………………………………………………………………….
Conformity statement without decision rule / Conformity statement with decision rule
Edward Food Research & Analysis Centre Limited, Barasat, W.B. MSP/SOP/WKI/FRM
TEST REQUEST FORM
Revision Number : 06 QA 15.0.0.1 Page 2 of 2

Remarks:

Reviewed By (Authorized Person): Date:

N.B. Please note that asterisk (*) marked fields are mandatory.